STATEMENT OF RUTH FANNING
DIRECTOR, VOCATIONAL REHABILITATION & EMPLOYMENT SERVICE
VETERANS BENEFITS ADMINISTRATION
BEFORE THE HOUSE COMMITTEE ON VETERANS' AFFAIRS
ECONOMIC OPPORTUNITY SUBCOMMITTEE
July 10, 2008
Madam Chairwoman and members of the Subcommittee, thank you for inviting me to appear before you today to discuss the independent living services provided by VA's Vocational Rehabilitation and Employment (VR&E) program. My testimony will provide an overview, address the cap of 2,500 new independent living cases per fiscal year, and describe VR&E efforts to improve and facilitate the delivery of these essential services.
Overview of Independent Living
Independent living services may be provided to VR&E applicants when it is determined during the initial evaluation that they cannot, due to the severity of their disability(ies), currently pursue a vocational goal. After this determination, each veteran participates in a thorough assessment of his or her potential Independent living needs. The evaluation begins with a preliminary assessment. During this assessment, the counselor obtains information about a variety of issues, including housing, personal and emotional needs; leisure and avocational activities; and the ability of the veteran to perform activities of daily living. If potential Independent living needs are identified, the VR&E counselor or another provider with specialized experience and/or training completes a comprehensive assessment of Independent living needs. This assessment is usually performed at the veteran’s home. If Independent living needs are found and it is determined that achievement of appropriate goals is possible, the counselor works with the veteran to develop an Independent Living Plan. This plan outlines the goals, services, and assistance to be provided and benchmarks to be used to determine progress in achieving greater independence in daily living.
Independence in daily living translates to the ability of a veteran to live and function within family and community, either without the services of others or with a reduced level of those services. Services are tailored to each veteran's needs and may include a discrete service or a comprehensive program of services necessary to achieve maximum independence in daily living.
Total programs of Independent living services are usually no longer than 24 months duration. In exceptional circumstances, the counselor may request a 6-month extension.
Some of the Independent living services VA provides include training in activities of daily living, training in skills needed to improve an individual's ability to live more independently, attendant care during a period of transition, transportation when special arrangements are required, peer counseling, housing integral to participation in a program of special rehabilitation services through an approved independent living center or program, training to improve awareness of rights and needs, assistance in identifying and maintaining volunteer or supported employment, services to decrease social isolation, and adaptive equipment that increases functional independence.
Independent living services may also help a veteran become able to participate in an extended evaluation. The purpose of an extended evaluation is to assess the ability of the veteran to achieve a vocational goal. Discrete Independent living services may also be provided as components of other rehabilitation plans. The Independent living services included in these plans must be directly related to the achievement of the plan goal, whether that goal is vocational training, a more extensive assessment of vocational feasibility, or employment.
The VR&E Officer must approve Independent living program costs exceeding the counselor approval limit of $25,000 per calendar year. Program costs exceeding $75,000 per calendar year can be approved by the Director of the VA Regional Office. Program costs in excess of $100,000 per calendar year and Independent living-related construction costs exceeding $25,000 must be approved by the Director of VR&E Service.
VR&E performs quality assurance reviews of Independent living casework. Cases are reviewed during oversight visits at regional offices, and the results are used to develop training or provide additional guidance when appropriate.
Independent Living Cap
With the passage of P.L. 107-103, the Veterans Education and Benefits Expansion Act of 2001, the limit on the number of new Independent living cases per year increased from 500 to 2,500. VR&E Service monitors newly developed Independent living cases monthly to track total Independent living cases in comparison to the legislative cap. Tracking over the past two years demonstrates the ability of VR&E counselors to provide needed services within the current 2,500 statutory cap. On average, 2,300 new cases have entered Independent living services each of the past three years.
Independent Living Services and Results
Veterans with severe disabilities who participate in programs of independent living have achieved results that include increased independence, decreased isolation, decreased dependence on outside supports, enhanced family relationships, improved medication and therapeutic intervention compliance, and greater community involvement. Other positive outcomes include veterans being able to leave long-term institutional care to live in the community with reduced reliance on other federally funded service providers, pursuit of full or part-time volunteer employment, and progression from Independent living programs to other VR&E employment programs.
As a result of increased outreach, we anticipate more veterans will participate in programs of Independent living services. Also, the medical stabilization of returning OEF/OIF veterans with catastrophic injuries will necessitate their participation in vocational rehabilitation programs. The aging Vietnam Era population and the increasing number of veterans receiving compensation due to presumptive diseases will also likely increase the utilization of Independent living services.
VR&E Service closely monitors the number of entering cases to ensure priority services are provided to veterans with the most serious disabilities. We also provide training and guidance to field staff to incorporate Independent living services into Individualized Written Rehabilitation Plans and Individualized Extended Evaluation Plans when appropriate.
Training
In early 2005, Guidelines for the Administration of the Independent Living Program were published and implemented. These guidelines include standards of practice and mandatory job aids for counselors. Use of these tools improved the quality and consistency of independent living assessments, plan development, service delivery, and case closures.
To reinforce the understanding and use of these tools and practices, VR&E Service provides targeted and extensive training about Independent living services for counselors and managers, including training workshops for vocational rehabilitation counselors directly responsible for developing Independent living plans and providing Independent living services.
As a part of ongoing Independent living training, VR&E Officers and Assistant VR&E Officers also receive information about community partnerships facilitating Independent living planning and service delivery. Building on collaboration with the Executive Director for Centers for Independent Living, a panel presentation at the recent VR&E Leadership Conference focused on information about Centers for Independent Living and current initiatives at these Centers to work with veterans with severe disabilities.
Another panel at the VR&E Leadership Conference addressed methods and services to facilitate the employment of individuals with severe disabilities, such as traumatic brain injury, post-traumatic stress disorder, spinal cord injury, severe mental illness, and polytrauma. Panelists included representatives from Easter Seals, the Vocational Rehabilitation Services Program sponsored by Paralyzed Veterans of America, and the Compensated Work Therapy program within the Veterans Health Administration (VHA).
Current and Future Studies
To obtain a more comprehensive understanding of the veterans who participate in Independent living programs, VR&E Service funded an Independent Living Participant Study. This contracted study will provide the first comprehensive analysis of the veterans, services, and outcomes achieved by veterans participating in total programs of Independent living services. This study will expand our knowledge about the disabilities and disability ramifications of Independent living program participants; the use of technology and adaptive equipment to minimize or ameliorate disability ramifications in daily life; and utilization of other VA benefits and benefits available through private providers or other state or federal sources. Recommendations to improve the administration of Independent living services under the VR&E program will be provided. The study is expected to be completed by September 30, 2008.
Next year, VR&E plans to fund a study to examine factors influencing the employment of individuals with severe injuries. Many of these individuals will initially utilize Independent living services, either in total programs of independent living or through Independent living services included in other rehabilitation plans. The objective of this project is to collect data and perform a comprehensive analysis of factors influencing the successful employment of veterans of the military with severe injuries. The population studied will include individuals with disabilities such as traumatic brain injury, spinal cord injury, blindness, amputation, severe mental illness, burns, and polytrauma. Recommendations will be provided on methods to improve employment outcomes and train counselors in working with and planning rehabilitation programs for servicemembers and veterans with severe injuries.
Cooperative Relationships
In cooperation with the Specially Adapted Housing Grant program administered by VA’s Loan Guaranty Service, VR&E independent living services help meet the needs of veterans with severe disabilities and mobility impairments. In 2005, VR&E Service and Loan Guaranty Service established formal procedures to facilitate cooperative relationships while maintaining the integrity of each program. When working with veterans who have home-modification needs, VR&E counselors investigate eligibility for the Specially Adapted Housing grant, and may assist the veteran in the application and coordination process. Specially Adapted Housing Agents, as part of their initial interview protocol, discuss potential eligibility for Independent living services. Specially Adapted Housing Program Managers regularly attend VR&E management conferences to provide information on the Specially Adapted Housing Program.
This cooperation has resulted in the delivery of life-changing services to veterans. In one instance, a veteran with quadriplegia received home modifications and a generator from the Specially Adapted Housing Program. Independent living services included adaptive equipment and assistive devices such as a voice activated computer and a flashing telephone and doorbell. Another veteran, blinded in Vietnam, needed a bedroom and bath constructed on the first floor of his home. VR&E and the Specially Adapted Housing Program were able to jointly complete these modifications, ensuring the veteran’s safety in his home and increased independence.
VR&E also works with programs administered by VHA, including the Home Improvements and Structural Alterations (HISA) program, the Automobile Adaptive Equipment program, and the Visually Impaired Services Team (VIST) program. The VHA provides HISA grants up to $1,200 for nonservice-connected veterans or up to $4,100 for service-connected veterans who need modifications to their homes to facilitate entry and provide access within the home.
VA's Automobile Adaptive Equipment program helps veterans or servicemembers who are service-connected for the loss or loss of use of one or both feet or hands, or who have service-connected abnormal adhesion of the bones of a joint of one or both knees or one or both hips. Veterans with severe burns resulting in a rating of loss of use of their extremities also qualify. The program can provide, among other things, power steering, brakes, windows, doors, mirrors, seats, automatic transmission, van lifts, wheelchair and scooter lifts, shipping costs, and other special equipment necessary to the individual.
VHA’s Compensated Work Therapy (CWT) programs provide supported employment opportunities for veterans with severe mental illness and other catastrophic disabilities, including traumatic brain injury and spinal cord injury. CWT programs are offered at over 162 locations across the country. The staff of these programs provide a range of vocational rehabilitation services to veterans who express an interest in employment. Any veteran may participate who has a severe mental illness or other severe disability and receives a referral from a VA Medical Center clinician or physician. For veterans with severe disabilities, CWT services can be an essential bridge from unemployment to employment.
VHA's Visual Impairment Service Team (VIST) offers a wide variety of services, including visual exams, devices to assist with daily living, and adapted computers and training to veterans with visual impairments. VHA also offers an array of prosthetic devices and services for patients based upon such factors as enrollment, medical evaluations, and prescriptions.
VR&E participates in work groups and committees that discuss and recommend policies to serve veterans likely to participate in Independent living services. These committees include the Committee on Care of Veterans with Severe Mental Illness (SMI) and the Traumatic Brain Injury Caregivers Panel. The SMI Committee is a VHA committee created to discuss, develop, and review VA treatment protocols, funding, and initiatives for veterans with mental illness. Members include VHA clinicians as well as members of service organizations and organizations dedicated to mental health issues in the private sector. Section 744 of the, P.L. 110-181, signed by the President on January 28, 2008, mandated the creation of the Traumatic Brain Injury Caregivers Panel. The purpose of the 15 member panel is “to develop coordinated, uniform, and consistent training curricula to be used in training family members in the provision of care and assistance to members and former members of the Armed Forces with traumatic brain injuries.” Panel members were appointed after receiving Department of Defense and White House approval.
Services to Seriously Wounded
VR&E is an integral part of a seriously injured servicemember’s or veteran’s adjustment and reintegration into their community. Working together with military treatment facilities, the Department of Labor, VHA, as well as VHA’s Care Coordinators, and VBA personnel, VR&E provides an optimal program of vocational rehabilitation and employment services to assist with seamless transition from military to civilian life.
Early intervention services for a seriously wounded OIF/OEF servicemember or veteran begins with a VR&E Vocational Rehabilitation Counselor directly contacting the individual to inform him or her about available benefits. This initial contact may occur while the servicemember is receiving treatment at a medical treatment facility, a VA Medical Center, or the individual’s home. VR&E staff is equipped to go anywhere necessary to deliver the initial orientation and provide assistance to the wounded warrior and his or her family.
This initial contact allows for the vocational rehabilitation process to begin earlier during medical rehabilitation and enables the veteran to make the transition quickly to work or to a program of employment services after he or she is discharged and ready to pursue vocational goals. This early intervention also gives hope to veterans as they readjust to their disabilities and plan for their future.
Once the eligible servicemember or veteran completes the initial orientation and the vocational assessment, a plan of service is developed to assist in meeting the individual’s vocational goals. In developing the rehabilitation plan, VR&E staff work closely with MTF and VHA personnel, communicating with medical teams to obtain current information about the veteran’s physical capacities and projected recovery timelines. VR&E is also collaborating with the new Federal Recovery Coordinators to ensure seamless and timely delivery of services.
For servicemembers and veterans who are physically recovering from catastrophic injuries and need independent living services in addition to planning for their vocational goals, an extended evaluation period may be needed. Individuals who are so severely disabled that a decision cannot be made about whether an employment goal is currently feasible may be provided an extended evaluation of more than the basic 12 months. VR&E Service has authorized field managers to approve extended evaluations for OIF/OEF servicemembers and veterans up to a total of 18 months.
Another tool to assist the injured servicemember or veteran is the “Coming Home to Work” (CHTW) initiative. The CHTW initiative began in September 2004 as a pilot at Walter Reed Army Medical Center. In November 2005, responsibility for CHTW was transferred to VR&E Service and became an integral part of VR&E’s early intervention and outreach efforts to OEF/OIF servicemembers. CHTW is established at all MTFs, with current staffing provided to thirteen Regional Offices serving major MTFs to support this initiative. CHTW provides opportunities for eligible servicemembers to fast-track into VR&E services, obtain work experience, develop skills needed to make the transition to civilian employment, determine the suitability of potential careers, and make the transition into competitive employment positions.
The need for early VR&E outreach through CHTW has grown and is no longer contained only within the major Military Treatment Facilities. The Department of Defense has begun assigning injured servicemembers pending medical separation to health care facilities across the country. In order to meet the increased need for early VR&E outreach, CHTW has been expanded to all VR&E field offices to focus on the development of solid working relationships with the military chain of command, government agencies, and the VA local service delivery team. This close coordination and collaboration is vital to the success of VR&E early outreach efforts for wounded servicemembers and veterans.
The Impact of Independent Living Services
This example highlights the impact that Independent living services have on our veterans. A veteran with an 80 percent VA disability rating applied for Chapter 31 benefits. He also had a multitude of non-service connected disabilities and used a wheelchair due to the difficulties he had with ambulation due to his disabilities and injuries. His Independent living goals included increasing his ability to access his home independently, increasing his ability to socialize, and enhancing activities of daily living by providing adaptive computer equipment and teaching him how to use the equipment.
Our VR&E counselor worked with a Rehabilitation Engineer to determine how best to increase the accessibility of the veteran’s home. Based on the engineer’s assessment and recommendation, VR&E provided for the installation of solar-powered remote-controlled gates on the veteran’s property. Prior to installing the gates, the veteran would have to manually open and close the gates. This was difficult for him due to his disabilities. Now, the veteran uses the gates daily and is able to come and go on his property without difficulty or pain.
During the veteran’s Independent living program, he began to interact with his community at a greater rate. He began to attend community events and joined a social club.
Using a computer was very important to this veteran and he had difficulty using a computer, as his injuries placed limitations on the use of his hands. The veteran’s Independent living plan included an adaptive computer, speaking software, and private instruction to teach him to use the equipment and voice activation software. Today, the veteran is able to use the computer to take care of his finances, communicate with family and friends, shop, and conduct research.
Concluding Remarks
VR&E anticipates an increased need for independent living services. We continue to assess our progress and develop methodologies and strategies to improve the delivery of benefits to these deserving veterans. Last year, over 2,700 independent living participants were rehabilitated – demonstrating they had achieved the goals of their programs or made substantial gains in independence as a result of VR&E services.
Madam Chairwoman, this concludes my statement. I would be pleased to answer questions from you or any of the other members of the Subcommittee.
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